Provider Demographics
NPI:1790396042
Name:AMAZING LIFE BEHAVIORAL HEALTH AND ADDICTION SERVICES
Entity Type:Organization
Organization Name:AMAZING LIFE BEHAVIORAL HEALTH AND ADDICTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:WILKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LADC/MH
Authorized Official - Phone:405-394-4209
Mailing Address - Street 1:18 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-7010
Mailing Address - Country:US
Mailing Address - Phone:405-476-8056
Mailing Address - Fax:
Practice Address - Street 1:324 N 19TH ST STE 101
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-2117
Practice Address - Country:US
Practice Address - Phone:405-394-4209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty